Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association. I also thank the Minister for repeating this Statement. Covid-19 Statements are now taking on the role of London buses—large gaps for a while and then suddenly two in one week on vaccines. It feels as though arguments were going on behind the scenes for such a quick second vaccine Statement to be repeated in less than two or three working days.
Like the noble Baroness, Lady Thornton, my honourable friend Daisy Cooper MP asked yesterday about the publication of the long-awaited impact statement —Making Vaccination a Condition of Deployment in Health and the Wider Social Care Sector—that this Statement refers to. It would have been helpful for MPs to have had sight of it at the same time as the Statement. As the noble Baroness, Lady Thornton, said, frankly we needed to see it a long time ago, given that the social care deadline starts tomorrow. It was finally published overnight, and I have some questions on it for the Minister.
The Statement announces that all NHS and social care staff will have to have to be fully vaccinated by 1 April 2022. The deadline for care home staff remains tomorrow. The predicted numbers on page 4 of the impact statement are pretty staggering—up to 126,000 staff, of whom 73,000 are expected to be NHS staff. Page 6 of the impact statement also says that the modelling cost of replacing unvaccinated workers is between £162 million and £379 million. That is also staggering, given the financial pressures and backlog of cases across a health and social care sector that at the moment is still struggling with the pandemic.
From these Benches we really want to see staff vaccinated but would prefer that it is voluntary and remain concerned about the consequences of tomorrow’s care homes deadline. Page 6 of the impact statement published overnight talks about the disruption to health and care services. But for social care that disruption has already started. Many care home staff have already left or this week are being fired, with a good number moving to the NHS and to retail and hospitality roles.
Large homes are reporting closing down wings of beds due to lack of staff and some smaller homes are handing back state-funded patients to local authorities. Both the Statement and the impact statement are silent on how patients will be looked after before we even get to the consequences of social care homes without beds.
So can I ask the Minister what emergency plans there are to help areas? By the way, answers that say “It’s down to local authorities” are not helpful. This is a crisis created, at least in part, by mandatory vaccines, and there are no staff or beds that can just magically appear. Or is what Sajid Javid said at the Conservative Party conference the reality: namely, that families will be expected to step up to the plate to look after their loved ones in the absence of care home beds? If so, it would be good to see Ministers’ planning for that and the consequent problems for the workforce.
The Statement says that other parts of the social care system—for example, domiciliary care—that were excluded from the original care decision will now be included, but neither the Statement nor the impact statement is clear about the deadline for those in the social care system now being drawn into mandatory vaccination. Can the Minister say what the deadline is for these new groupings? It surely cannot be that the deadline for domiciliary workers is this week. Is this just for full-time staff employed by the care sector, or will others offering regular services such as activities in care homes or subcontractors working in hospitals now be included? There are staff working as sub- contractors for the NHS who have front-line access to patients; for example, delivering meals. Are they included or excluded?
The table on page 4 of the impact statement lists the total number of staff in each sector exempt from vaccination. I cannot find anywhere the criteria for exemption. Can the Minister please tell the House what those criteria are?
I have now asked the Minister at least twice in the past fortnight about the online vaccination form which sits behind the GP records and the app. How many of those who were vaccinated overseas and those who took part in clinical trials are now on the records system? Has it increased from the 53 people that he talked about last week, and are the arrangements for logging third doses for the severely clinically extremely vulnerable, as distinct from the booster doses for everyone over 50 and health staff, now sorted out? I am still getting reports that they are not.
Finally, there has been considerable concern that the Prime Minister was not wearing a face mask at Hexham hospital yesterday, against all NHS advice. This morning, Dr David Nabarro, the World Health Organization’s special envoy for Covid-19, said on Sky News:
“I’m not sitting on the fence on this one … Where you’ve got large amounts of virus being transmitted, everybody should do everything to avoid … getting the virus or inadvertently passing it on. We know that wearing a face mask reduces the risk. We know that maintaining physical distance reduces the risk. We know that hygiene by regular hand washing and coughing into your elbow reduces the risk. We should do it all, and we should not rely on any one intervention like vaccination on its own. So … please, would every leader be wearing face masks, particularly when in indoor settings? … This virus is unforgiving, and we need to do everything possible to prevent it getting in between us and infecting us.”
Can the Minister explain why the Prime Minister was not wearing a face mask, in breach of Hexham hospital’s rules, and will he pass on those words from Dr Nabarro to No. 10 Downing Street?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank both noble Baronesses for their questions and the important points they made. It is important that we are clear about many of the issues that they have brought up.
Let us be clear that the best mitigation against this is to encourage those who are vaccine hesitant to take up the offer of vaccination. In both health and social care, we have worked extensively with key stakeholders and arm’s-length bodies to encourage vaccine take-up. This has involved a number of different measures: bespoke communications materials, paid advertising, stakeholder toolkits, positive messaging using influencers and leaders, content in different languages, briefings with different faith groups, webinars with clinical experts, vaccine champions and practical support including vaccination at places of work, flexible access to vaccine hubs, digital booking support and monitoring and support from NHS England. We will continue to encourage uptake in the run-up to the requirements coming into force.
The NHS has also focused in recent months on a targeted approach to improve uptake in hesitant groups by undertaking specific, targeted campaigns directed towards, for example, midwifery staff, ethnic minority groups in certain areas that have been hesitant and students, as well as using the booster campaign as an opportunity to re-engage staff. I thank noble Lords across the House for the advice that they have given me on how we can address hesitancy in some communities and for their very useful suggestions. I have discussed this with a number of other people, and we are looking at potential pilot projects, one working, for example, with faith communities in inner-city areas and mapping the data from Public Health England and the relevant offices.
It is interesting to see how many absences are due now to the unvaccinated. The seven-day average to 6 October 2021 shows an average of 74,863—nearly 75,000—absences in NHS trusts per day, of which more than 15,500 were for Covid-19-related reasons, including the need to isolate. This benefit would be reduced if we relied only on testing, although that remains part of our armoury.
I was asked a number of questions about scope and who this extends to. It applies to all providers, both public and private, of a CQC-regulated activity. This obviously covers a wide range of services, including hospitals, GP and dental practices, and social care providers. Further support on implementation for the sector will be provided through continuous guidance. The policy does not apply to those services and activities which are not regulated by the CQC. Children’s and social care services which are CQC regulated will be in scope of the requirement, but it will not apply to services that are provided as part of shared-living arrangements. Many of these reasons are of course as a result of the extensive consultation that has been undertaken.
I was asked for the number of uptakes. The vaccination uptake figures for NHS staff show that nearly 93% have had at least one dose. Uptakes still vary, from 84% to 97% for the first dose, among NHS trusts. Among primary care workers, this ranges from 94% in the south-west to 76% in the east of England—so we would welcome the advice of any noble Lords who have experience of the east of England. In adult social care, nearly 84% of domiciliary care staff have received one dose of the vaccine, and nearly 75% have had a full course of a Covid-19 vaccine, as of 14 October, which we believe represents the best proxy for the workforce in scope of the policy in other settings, too. So, despite our best efforts, there is still much more that we can do. I personally feel very uncomfortable about compulsion, but I also understand the arguments on both sides when I meet many patient groups and others who tell me that, if they were in hospital or a care home or had relatives there, they would feel much better if the staff were vaccinated and were protected.
What more can we do? The Covid-19 vaccines have been approved by the MHRA as safe and effective, and we continue to send that message out. Analysis suggests that the Covid-19 vaccination programme prevented more than 100,000 deaths in England as of 20 August. We continue to have targeted engagement. The NHS plan also includes one-to-one conversations for all unvaccinated NHS staff with their line manager, with clear guidance on how to do this. We have found that such one-to-one conversations are working in some cases. We want to make sure that we listen as well, hearing concerns that are seen to be legitimate as well as concerns that are not medical reasons but other reasons that staff may have for being so hesitant. It is really important that we understand, and that was all part of the extensive consultation.
We are trying to increase the number and diversity of opportunities. We are using the booster campaign, walk-ins and pop-ups for not only the public but staff as well.
A question was asked about pregnant women. Short-term exemptions from requirements are available to those with short-term medical conditions, but also including pregnancy. For pregnant women, the exemption expires 16 weeks after childbirth. This will allow them to become fully vaccinated after the birth. We will set out these arrangements, as has been called for by noble Lords, in the guidance on exemptions.
As noble Lords acknowledged, we set out yesterday an assessment of the impacts alongside the laying of the regulations. We also published a full impact assessment yesterday for the original care home regulations, and I thank the noble Baroness for acknowledging that. As committed to by my right honourable friend the Secretary of State in the other House yesterday, we will publish a full impact assessment for the regulations as soon as possible, and before Members vote on the proposed legislation. I recognise that Peers will be keen to understand the impacts of the policy as soon as possible and as part of consideration of the regulations. However, I hope that noble Lords will appreciate the necessity of trying to move as quickly as possible to ensure that patients are protected and that workers are given as much notice as possible. We will set out the statement of impact, which noble Lords will be able to consider, and it will be published before Members cast a vote.
We have done a number of things on vaccine hesitancy, and I have laid them out already. We want to encourage as many people as possible to take up the vaccine ahead of the regulations, which is one reason why we have the grace period until 1 April next year. The individual worker maintains a choice as to whether they decide to have the vaccine. Even if they choose not to have the vaccine, the registered person may redeploy them to a non-patient-facing role. When that is not possible, the worker cannot be employed or otherwise engaged by the registered person. This is incredibly important when it comes to patient-facing staff, especially for the families of those patients who are deeply concerned that their loved ones may be infected by unvaccinated staff.
I was asked how the measure will be enforced. On the approach to vaccination requirements, it is the CQC’s role to monitor and take enforcement action. At the time of registration and when inspected, health and care providers would need to demonstrate that they have effective systems in place. There are a number of measures in place to support care home workers. The majority of care home staff are now fully vaccinated, but there are a number of different programmes. Given the time, I shall not go into them but, if noble Baronesses would like more details on those encouragement programmes, I should be happy to write.
Lord Kamall (Con)
I thank the noble Lord for giving me notice of his question just before we came in. I tried to get an answer as quickly as possible, and I apologise that that answer has not arrived. I want to make sure it is absolutely right and that I am certain that I do not mislead the House unintentionally.
Baroness Walmsley (LD)
My Lords, as we move towards 1 April, I want to raise the issue not just of the concerns of staff, which the Minister has rightly mentioned, but the concerns of patients. Could patients in a ward, an NHS clinic, primary care or any other health setting be informed as to which members of staff have not been vaccinated? Would they then have the right to politely request that they are treated only by vaccinated staff?
Lord Kamall (Con)
The noble Baroness makes a very interesting point and an interesting suggestion. I am not quite sure of the details absolutely on those issues—as I said, further guidance will be published. But I promise to write to her, as she so gallantly intimates or hints.
Lord Framlingham (Con)
Does the Minister appreciate that quite a lot of people find the idea of compulsory vaccination absolutely intolerable, for all sorts of reasons, however beneficial it may be? This is a serious move for the whole country. Yesterday, in the House of Commons, I believe that the last Secretary of State said that he would not mind the same conditions being applied to flu. Just where does this end?
Lord Kamall (Con)
I thank my noble friend for the question. As noble Lords will know, I see myself as a bit of a civil libertarian. Personally, I have asked a number of questions internally about the whole issue of compulsion. It is a very difficult issue, but I understand the arguments on the other side—that we want patients to feel safe and feel that they are looked after by staff who have been vaccinated. Stakeholder analysis and round-tables came out in favour of compulsion on the Covid vaccine and boosters. When it came to flu, interestingly enough, there was a significant disagreement on the practical timing of the flu vaccine supply and the vast majority of doses being available. We have promised to keep it under review, but that is not mandated at this stage.
Baroness Watkins of Tavistock (CB)
My Lords, I declare my interest as a mental health nurse, as outlined in the register. I am concerned about the unintended consequences of making vaccines mandatory for healthcare staff, despite the fact that I fully support the vaccine and have had three doses myself. It is a relatively small number of healthcare staff who are not vaccinated—I accept that it varies across the country—but is it right to give no authority at all to boards in trusts to decide the best way forward for the minority of staff who do not wish to be vaccinated? I am concerned that there will be unintended consequences associated with a lack of care staff, particularly nurses, in mental healthcare environments, which may result in poorer care for patients than if we carefully supported that small number of staff in working perhaps with patients who do not want to be vaccinated themselves.
Lord Kamall (Con)
I start by thanking the noble Baroness, not only for her question but for the conversations that we have had to help my understanding of the subject and the consequences of some of these actions. I welcome the expertise from across the House when it comes to a number of health-related issues.
The consultation quite clearly said that many felt that vaccines remain our best defence against Covid-19 and that the vaccination programme has prevented thousands of hospitalisations and deaths in the UK. The more staff who are vaccinated against Covid-19, the more likely it will be that vulnerable people in their care, and other colleagues, are protected. Several studies have provided evidence that vaccines are effective at preventing infection and transmission—and beyond preventing infection have an additional benefit of reduced transmission by those individuals who become infected despite vaccination because of a reduced duration or level of viral shedding.
On the specific question, I am sure that the noble Baroness recognises—as I know from when we discussed these issues—how complex this issue is. There are ethical and health issues, and the concerns of patients and their families, who feel much more comfortable about being treated by staff who are vaccinated.
Baroness McIntosh of Hudnall (Lab)
My Lords, I think that there are probably very few people, apart from hardened anti-vaxxers, who do not accept that vaccination is good and that it has done a huge amount to reduce the impact of the pandemic, which has had such devastating effects. However, following on from the question from the noble Baroness, Lady Watkins, it would appear likely that there will be not unintended but predictable and intended consequences as a result of this policy, which is that some NHS staff, and, more immediately, some social care staff, will simply give up doing what they do. In those circumstances, what advice is the Minister or his Government offering, particularly to private sector care homes, as to what they should do if faced with staff losses other than simply to reduce their capacity to take in new patients?
I noticed that the Minister did not pick up the question from the noble Baroness, Lady Brinton, about the example that people in public life—I name nobody in particular—can set by wearing their masks, appropriately, on all occasions when it is sensible to do so. What encouragement can he offer to the rest of us about further examples being set on that front?
Lord Kamall (Con)
There clearly are concerns. These were expressed in the stakeholder engagement that occurred with both the social care sector and other sectors that will need to bring this in from March next year—we are bringing it in now but with a grace period until next March. A lot of this engagement and consultation discussed how we can support staff who are unwilling to be vaccinated as well as understanding their concerns and whether employers see these as legitimate.
Thinking back to the beginning of the crisis, one of the reasons this was called for in care homes as quickly as possible was the data from the early part of the pandemic, when there were a disproportionate number of deaths in care homes. A number of people, including patient groups and families of patients, were quite adamant that if their relatives were in a care home, they wanted to make sure that they were being looked after by staff who had been vaccinated.
There is another vaccine that is a condition of deployment, that for hepatitis B. I have asked medical staff whether they are concerned about this and a number have said no, because they are already compelled to have the vaccine for hepatitis B. That is a condition of deployment and staff see this vaccine as just as essential. That assuaged some of the concerns I had over compulsion. These are difficult, unprecedented times. We would not ordinarily want to go with compulsion, but the health of the nation is at risk and many people want to feel much more reassured that they, or their family members who are receiving care, are looked after by people who have been vaccinated.
Lord Scriven (LD)
Evidence-based policy is really important on this. Statistics from the Nuffield Trust show that, with the mitigations that healthcare and hospitals are putting in place, hospital-acquired Covid rates have been coming down since the middle of the year, while rates in the community have been rising. The reason for that is that the mitigation includes face-covering measures which, as the NHS Chief Nursing Officer, Ruth May, said in July,
“will remain in place across healthcare settings so that the most vulnerable people can continue to safely attend hospital”.
If that is the case, why was the Prime Minister not wearing a face covering when in a hospital this week?
Lord Kamall (Con)
I thank the noble Lord for that question and other noble Lords for their questions. I am not the Prime Minister’s keeper; it is as simple as that. We all decide for ourselves. I wear a mask whenever I can and when I talk to different people, I make sure that we are seen to be wearing masks. I thank noble Lords across the House who are leading by example by wearing a mask.
Baroness Pitkeathley (Lab)
Patients in care homes and hospitals suffered very badly from not receiving visitors during the three lockdowns. Family ties were strained and a lot of extra distress was caused. From next April, if all, or the majority of, health service staff are vaccinated, what plans do the Government have for ensuring that visitors do not bring Covid into hospitals and care homes?
Lord Kamall (Con)
In many cases, that decision will be left to the individual trust or care home. We know that a number of care homes and different trusts are already concerned about unvaccinated visitors. Many will know already that during the previous lockdowns it was very difficult to visit your loved ones in hospital. I was not able to see my father between January last year and when he died last September. It was incredibly challenging, but we understood the reasons given by the care homes.
Lord Watts (Lab)
The wearing of masks is a public health issue. It should not be left to individuals to make a decision on whether or not to wear a mask when they are coming into contact with vulnerable people. Can the Minister explain why the Prime Minister takes the view that he does not need to wear a mask?
Lord Kamall (Con)
I thank the noble Lord for pressing on that point, as a number of others have. I am assured that the Prime Minister and his team followed all the rules that they were required to follow in that hospital, whether about face masks or otherwise. This is what I have been informed and it is all I can report.
Baroness McIntosh of Hudnall (Lab)
Since we have a little time left, could I ask the Minister to go back to the question of the support that care homes, hospitals and other healthcare settings may need in the not unlikely event that they will lose staff as a result of this policy? I completely understand that vaccination is highly desirable and that the intention is to encourage people to be vaccinated. However, it is pretty clear that some will not be and that will have an impact. What support will be on offer in healthcare settings to people who are having to cope with the impact of losing staff as a result of this policy?
Lord Kamall (Con)
In consultation with the social care sector and the wider NHS, including trusts, discussions have looked at the impact and what would happen, but also how to make the message more positive, how to encourage staff to take up vaccines and how to listen to their concerns. In some cases, employers have said that they do not feel that staff have given a legitimate reason for not taking up the vaccine, but they are also under pressure from patients’ families to make sure that they employ care staff who have been vaccinated. They are trying all the different areas of persuasion, including targeted campaigns and one-to-one conversations in some cases, to encourage them as much as possible. At the end of the day, even before the introduction of vaccinations as a condition of deployment, many care homes were already trying to push their staff to take vaccinations because they are concerned about their patients.
Lord Scriven (LD)
As we have time, the Minister has just said from the Dispatch Box that the Prime Minister was following the rules of the trust he visited. That trust says on its website that you must
“wear a face covering when you enter the hospital until you leave”,
and adds:
“You must ensure that you wear your covering or mask throughout your visit and you must not remove your face covering/mask or kiss your loved one.”
By not wearing a mask, in either a clinical or non-clinical area, how was the Prime Minister carrying out the policy of that trust to try to save vulnerable people from being contaminated with Covid-19?
Lord Kamall (Con)
Whenever I have visited hospitals during the lockdowns or restrictions, we have sought advice from the staff around us. We have asked what measures are appropriate and whether we should keep face coverings on at all times. There have been times when they have said that, in particular areas, you can take your mask off. I was not at the visit yesterday, as I am sure the noble Lord will acknowledge—in fact, I was here answering questions—so I cannot go into detail. However, having visited hospitals myself, I am aware that you go in wearing a mask by default, but there are times when staff say, “In this area, you can take it off”.
Lord Campbell-Savours (Lab)
Is not the answer to the question asked by my noble friend that the Prime Minister was acting irresponsibly and was wrong?
Lord Kamall (Con)
I am afraid that I was not there, so I do not know what advice he had been given at that moment by that particular trust. Noble Lords can do trial by TV as much as they like, but while you go in with a mask on by default, when you are there with workers from the NHS who are often giving advice, they may say at times, “In this part, it’s fine. You do not need to do that.” That may well have been the case, but I am afraid that I do not know the details.